The Wild Ride of Infertility, Pregnancy, Parenting, and All of Life's Little IFs.

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I study American government, and I’ve spent years being told that America is exceptional in its politics, in its history, in its social, racial and intellectual diversity. But there’s another way that we’re exceptional, a way that we don’t learn about in school and that politicians don’t brag about for political capital.

There are 178 recognized countries in the world. 175 countries require employers to offer paid maternity leave to new mothers. The United States is one of the three exceptions, and the only first world country without a paid maternity leave law. (The other two countries are Swaziland and Papua New Guinea.)

Within the US, just two states offer paid family leave to men and women—New Jersey and California—but the statutes do not guarantee that employees who use their paid leave can’t be fired as a result.

Now, every state is required to follow the Family and Medical Leave Act of 1993 (FMLA), a piece of legislation that requires qualified employers to provide up to 12 weeks of job-protected, unpaid leave to workers who need to deal with medical and family issues.

Twenty years ago, the passage of FMLA was rightly considered a huge victory for former president Bill Clinton; but the victory should have been considered the first step, not the last, toward ensuring that no one is ever forced to choose between their careers and their family.

FMLA cannot be the last step because if you work for a company that employs fewer than 50 people, or you work part-time, or you’ve worked for a company for less than a year, or you need to take care of extended family or grandparents, your leave isn’t protected under the law. In fact, a staggering 40 percent of the workforce isn’t protected.

And stories reported by those that are covered indicate that the law is loosely enforced and often inattentive to the actual needs of employees: a new mother will take her three months of leave to care for a newborn, only to return to the workforce with a decreased salary, a demotion, or an office half the size of her old one. A mother put on bed rest prior to the birth of her child is fired for not returning to work when her leave is technically up but her child is only 12 days old. A man is fired for just requesting leave in order to care for his ailing, elderly parent. Another is fired for requesting time off to take his dying father to the hospital.

Where are our priorities?

After all, the Department of Labor, the administrative body responsible for overseeing FMLA, has stated that the law is intended “to balance the demands of the workplace with the needs of families,” but it sounds like the demands of the workplace, specifically the demands of employers, are being prioritized over families.

When the law was first under review, lobbyists for the business community demanded that any legally mandated leave be unpaid. Their reasoning? Monetary benefits, they said, would encourage employees to abuse the leave policies. And of course, they also argued that paid leave would economically punish the employers while rewarding the employees.

But if the purpose of the law is, in fact, to help balance the demands of the workplace with the demands of families, is unpaid leave really enough?

The types of situations that warrant leave under the FMLA are all costly: a new baby, a close family member in the hospital, an employee’s own medical needs. Unpaid leave might guarantee that these people don’t lose their jobs as the result of a pregnancy or unforeseen medical issue, but it certainly doesn’t help cover the costs of supporting the very families they’ve taken time off for.

Let’s go back to maternity leave as an example, and let’s think of the average middle class American woman. 12 weeks of leave might give her enough leeway to prepare for a new baby, recover from delivery, and bond with the newborn. Maybe. But what if she’d previously provided 47% of her family’s income, as so many middle class women do? In all likelihood, that family is going to be severely impacted by three months with only half of the earnings it’s used to. Is that family’s needs really being met?

All of this isn’t to say that FMLA is a bad law. According to government estimates, 100 million workers have taken advantage of government-guaranteed family leave. The problem is that FMLA doesn’t go far enough, it doesn’t prioritize families. As a country, we’re not doing as much as we can to ensure that people who work hard every day are never asked to choose between putting food on the table or being with a sick loved one in the hospital.

We must put pressure on our politicians to reevaluate family leave laws. Call your congressmen. Write to your senators. Share your stories. Insist that your lawmakers listen to your stories, that they know how your family is impacted by a lack of useful family legislation. Tell them that this is an area of public policy where America can no longer stand to be exceptional. As Best for Babes co-founder Danielle Riggs puts it, “[Family and maternity leave] is very serious. This is not a woman’s issue; this is not a sideline issue. This is a front and center issue, a human rights issue.”

Both the American Society for Reproductive Medicine and the American College of Obstetricians and Gynecologists have classified infertility as a disease affecting the functioning of the reproductive systems, although many couples have no actual disease or explained reason for their infertility issues. Over 7 million people, or 1 in 7 couples of reproductive age, are afflicted with infertility issues. Yet, in the United States, only 15 states require insurance companies to offer any coverage for fertility treatments. And in many of the states that do require some coverage, insurance companies are able to use loopholes and restrictions to make access nearly unattainable anyway.

The result of these often arbitrary insurance guidelines is that for many couples and individuals coverage for infertility issues is as hard to come by as coverage for elective procedures, if not harder. Most insurance companies site cost as a reason to limit coverage; others argue that fertility treatment is elective because the inability to conceive does not threaten the overall health of the patient. But both arguments ignore the very tangible negative effects a battle with infertility can cause.

The effects of infertility reach beyond the inability to conceive. Infertility has been connected with increased rates of stress, depression, and anxiety, as well as strained relationships with partners, family, friends, and employers. For many, the inability to conceive has the same detrimental impact on psychological health as a sudden traumatic experience.

Yet despite the overwhelming evidence that infertility is a psychologically and physically debilitating problem for many, when the Institute of Medicine (IOM), an independent medical advisory board, met in 2011 to offer advice for the new state-by-state coverage requirements under the Affordable Care Act, their report made no mention of fertility treatments.

The report does emphasize the need for required maternity and newborn services, mental health services, preventative and wellness services, as well as chronic disease management. But the report also encourages insurers to weigh treatment costs with their effectiveness before providing coverage. Most companies cite costs as their primary reason for not currently offering coverage, and though the success rate of fertility treatments range from 59 to 85%, insurers could still argue that the costs outweigh the risk of ineffectiveness.

The potential for this report to further hinder the coverage of infertility treatments is especially tragic in light of some additional data: over 90% of insurers that cover fertility treatments (including fertility drugs and, in some cases, in vitro) report no additional overall health care costs.

It makes sense that health care costs would remain relatively stagnant despite coverage of fertility treatments. First, the availability of coverage does not negate the psychological and physical toll conception through IVF or similar treatments usually requires. For most people, the decision to go through treatment will still be a tough one, and the likelihood of a sudden, exponential increase in the use of fertility treatments seems slim.

Second, the availability of treatment for those who have spent years navigating the heart-wrenching waters of failed attempts at conceptions—weighing the deep, unshakeable desire to have a child with the potential of a string of physically taxing procedures, financial instability, and further disappointments—may lead to decreased use of mental and physical health services down the line. Much of the psychological stress (and resultant physical stress) fertility patients experience is directly related to the financial difficulties many face in trying to pay for treatment. Subsidized or fully insured coverage could relieve a lot of the stress-related medical costs associated with fertility treatments. And, in the face of something as emotionally and physically taxing as an infertility crisis, medical bills should not have to be an added stressor.

In light of the available information, resistance to fertility treatment coverage seems to have little grounding in medical or economic research. Yet we don’t seem to be any closer to guaranteeing access for the 7 million people suffering from infertility issues. One light at the end of the tunnel might exist, however: the same IOM report suggests that the coverage guidelines be reworked every year to fit the changing demands of the medical industry.

As responsibility for insurance guidelines shifts to the states in the aftermath of the Affordable Care Act, the issue of infertility coverage will become increasingly political. And in this case, the politicization of an issue could be beneficial—because political means public, and public means public-influenced.

So now, it’s time to rally for the cause. Join (or start) a support group; write to your congressmen, state representatives, and senators; attend a National Infertility Awareness Week event; encourage your friends and family to learn about infertility. Whatever you do, make it clear to your local and national leaders that infertility treatments need to be covered, that those afflicted need support, not added costs and stress. Let’s spread the word, spread awareness, and make sure the next IOM report provides a little more justice.